Provider Demographics
NPI:1790033934
Name:CARPENTER, DAWN RENE' (APRN)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:RENE'
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:502 S UPPER RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:KY
Mailing Address - Zip Code:40445-8743
Mailing Address - Country:US
Mailing Address - Phone:606-224-7145
Mailing Address - Fax:606-453-9420
Practice Address - Street 1:9226 MAIN ST, STE D
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:KY
Practice Address - Zip Code:40445-8743
Practice Address - Country:US
Practice Address - Phone:606-453-3901
Practice Address - Fax:606-453-9420
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3007633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100218701Medicaid